| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,442 |
2,344 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,830 |
2,736 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
2,111 |
2,064 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
487 |
$13K |
| D0272 |
Bitewings - two radiographic images |
535 |
518 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
50 |
$5K |
| D1110 |
Prophylaxis - adult |
101 |
97 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
57 |
$1K |
| D1354 |
|
21 |
12 |
$315.00 |